脓毒症儿童的营养风险与营养支持研究进展

儿童脓毒症是危重病医学所面临的主要课题。有关研究表明,营养风险可能是间接影响脓毒症发生率及病死率的危险因素之一。通过营养风险筛查与评估,为评定脓毒症患儿是否具有营养风险、是否需要营养支持以及营养支持对患儿预后的影响提供参考依据。目前国内有关脓毒症儿童营养风险及营养支持的研究报道较少。本文主要对脓毒症儿童的营养风险与营养支持的研究进展作一综述。     

儿童长期机械通气的营养支持策略

接受长期机械通气的儿童近年呈明显增加趋势。营养支持对改善长期机械通气儿童的预后十分重要。目前尚缺乏有关长期机械通气儿童营养支持的相关研究及专家共识或指南。本文结合目前的研究成果,简要总结了长期机械通气儿童营养支持的流程和策略。多学科协作有助改善营养支持的效果。尚需大量高质量研究提供循证医学证据,以制订更加合理规范的营养...     

小儿外科病人的肠内营养支持

目的 探讨小儿外科病人实施肠内营养的优越性和可行性。方法 87例小儿外科住院病人分别经口、鼻胃管及空肠造瘘管予以小儿安素,自然过渡到正常饮食。对比肠内营养前后患儿的体重、身高、上臂肌围、三角肌皮褶厚度、血红蛋白、血球压积及血清总蛋白,通过前后比较就肠内营养对患儿的营养状态、肠道功能的影响作前瞻性随机化研究。结果 受试患儿身高、体重、上臂肌围、三角肌皮褶厚度于2周后开始增加,8周后明显增加。长期测量血红蛋白、血球压积及血清总蛋白均有所增加。结论 小儿外科病人施行肠内营养是可行的,能避免负氮平衡,改善机体的营养状态。     

儿童肿瘤患者的营养支持

随着医疗水平的不断提高,手术、放疗、化疗极大地提高了儿童恶性肿瘤的治愈率[1]。目前在发达国家总体治愈率超过70%,预计2010年可到85%。但与此同时,因肿瘤本身或肿瘤治疗副作用的影响所导致的营养不良,特别是蛋白质/热量营养不良(PEM),削弱了患儿对各种治疗的耐受性,增加并发     

关注疾病状态下儿童的营养支持

患儿的营养状况将影响其疾病康复和预后。在我国,对儿科营养重要性的认识和规范化应用,远远落后于发达国家。为进一步提高我国临床各科对此问题的认识,本刊特设此专题进行讨论,十分必要。下面就国内外相关情况     

人体成分分析在儿童肿瘤患者营养评估中的应用进展

儿童肿瘤患者因肿瘤负荷和肿瘤治疗的综合作用,营养不良发生率增高。传统营养指标(如体重、体重指数和白蛋白等)不能区分脂肪组织和肌肉组织,在评估儿童肿瘤患者营养状况时尚存在局限性。近年来,人体成分分析技术迅速发展,其不仅能获得人体各组分的客观质量,还可以纵向监测营养状况,因此在准确评估儿童肿瘤患者营养状况和制定个体化营养支...     

重症儿外科儿童的营养支持

外科营养支持疗法诞生于上世纪60年代,与抗生素的发展、麻醉学的进步、重症监护与器官移植等一起被列入20世纪的重大医学进展 1987年,Cerra提出了代谢支持（metabolic support）理论,旨在提供机体所需要的最低营养底物.     

血液肿瘤患儿营养支持

营养不良在血液肿瘤患儿中为常见问题。疾病及治疗过程中的并发症可影响患儿的营养状况。肿瘤的预后不仅取决于其本身特性,还与患儿的营养状况密切相关。营养支持是现代医学研究重大进展之一,在肿瘤综合治疗     

围手术期营养筛查及营养支持对儿童快速康复的作用

临床营养学是运用营养学知识来治疗疾病,提高机体免疫力,促进康复的科学。合理平衡的营养,不仅可以增强患者的免疫能力,预防疾病发生和发展,而且还可以提高患者对手术和麻醉的耐受能力,减少术后并发症,降低医疗成本,缩短住院时间,改善临床结局。临床营养支持治疗是2O世纪是继麻醉、消毒、抗生素之后外科领域的第四个具有里程碑意义的进展。经过50年的发展,已成为当代医学治疗的重要部分,推动临床医学的不断进步。     

Family-Centered Assessment and Function for Children With Chronic Mechanical Respiratory Support

IntroductionThe purpose of this study was to assess health-related quality of life (HRQL) when managing severe, chronic respiratory insufficiency (CRI) at home.MethodsFamilies enrolled in a comprehensive program for CRI completed the Child Health Ratings Inventories with (a) parent-proxy ratings of the child's HRQL and (b) the parent's own HRQL. Psychometrics and known groups comparisons were reported. Linear regressions models assessed the effect of the parent's HRQL on proxy ratings.ResultsEighty-six parents (67%) completed the measures. The child global HRQL score was low (63.1, SD = 24.9), although ratings of “family life” were higher (73.8, SD = 26.5). The parent global HRQL and emotional functioning (EF) scores were low, despite preserved physical and role function. Having a child with a congenital versus an acquired disability was associated with higher parental EF (p = .004). Higher parental EF correlated with a higher global child HRQL (p < .001).DiscussionFamilies of children with CRI experience reduced HRQL. The Child Health Ratings Inventories is a valid tool for this assessment, identifying emotional distress and potential gaps in support.     

Assessment of Nutritional Status in Children With Cancer and Effectiveness of Oral Nutritional Supplements

Malnutrition is a common consequence of cancer in children, but the most effective methods of nutrition intervention are under debate. We aimed to evaluate the nutritional status of children diagnosed with cancer, and to investigate the effect of oral nutritional supplements on anthropometric measurements, biochemical parameters, and outcome. A randomized clinical study of 45 newly diagnosed cancer patients was performed. Anthropometric and biochemical data and related factors were assessed at 0, 3, and 6 months after diagnosis. On initial anthropometric assessment, prevalence of malnutrition by weight or height was found to be lower as compared with body mass index (BMI), or weight for height (WFH), or arm anthropometry. Twenty-six of the patients (55%) received oral nutritional supplement. During the second 3 months after diagnosis, there was a statistically significant decrease in number of the patients with WFH <90th percentile and BMI <5th percentile (P = .003 and P = .04, respectively). Infectious complications occurred more frequently in malnourished patients during first 3 months, and survival of children who were malnourished at the 6th month was significantly lower than that of well-nourished children (P = .003). On laboratory assessment, serum prealbumin levels of the all subjects were below normal ranges, but no relation was found for serum prealbumin or albumin levels in patients who were malnourished or not at diagnosis. Nutritional intervention is necessary to promote normal development and increase functional status as a child receives intensive treatment. Protein- and energy-dense oral nutritional supplements are effective for preventing weight loss in malnourished children.     

Subjective Global Nutritional Assessment: A Reliable Screening Tool for Nutritional Assessment in Cerebral Palsy Children

Objective

To determine the prevalence of undernutrition in children with cerebral palsy and to compare subjective and objective methods of nutritional assessment.

Methods

This was a hospital based analytical observational study in which 180 children of cerebral palsy, aged 1–12 y, attending tertiary level hospital, Jaipur from March, 2012 through March, 2013 were included. Subjective assessment was done by questionnaire (Subjective Global Nutritional Assessment; SGNA) in which questions related to nutrition history and physical examination, signs of fat, muscle wasting and edema was done while objective assessment was done by weight, height and triceps skinfold thickness (TSFT) measurements.

Results

In this study prevalence of undernutrition by subjective method (SGNA) was 76.67% while by objective measurement (weight, height, TSFT) was 48.89%, 77.78% 35.18% respectively. There was fair to moderate agreement between the SGNA and objective assessments including weight and height (k = 0.341, p = 0.000; k = 0.337, p = 0.000 respectively) while for TSFT agreement between both methods was poor (k = 0.092, p = 0.190). In the index study, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SGNA was for weight was 95%, 37%, 56%, 90%; for height 84%, 50%, 85%, 47%; for TSFT 81%, 30%, 38%, 75% respectively.

Conclusions

The prevalence of undernutrition is high in cerebral palsy children. SGNA can be a reliable tool for assessing nutritional status in children with cerebral palsy and is a simple, comprehensive, noninvasive, and cost-effective tool for screening undernutrition in children of cerebral palsy.

     

儿童后颅窝肿瘤的诊治特点

目的对儿童后颅窝肿瘤的临床特征、病理类型、手术切除及术后并发症进行分析。方法回顾分析我院儿童(15岁以下)后颅窝肿瘤30例，术前头颅CT及MRI确定肿瘤位置分别采用咬骨窗开颅(21例)和骨瓣开颅(9例)显微镜下切除肿瘤。结果全切除肿瘤20例，近全切除肿瘤10例。无手术死亡。术后病理证实：星形细胞瘤9例，髓母细胞瘤14例，室管膜瘤4例，恶性室管膜瘤3例。结论MRI能清楚地显示肿瘤的大小、部位、范围和界限，根据肿瘤不同部位选择最佳的手术入路，显微镜下暴露肿瘤最直视的部位分离肿瘤，可安全地全切除或近全切除肿瘤。     

小儿原始神经外胚叶肿瘤6例临床分析

目的提高对小儿原始神经外胚叶肿瘤的认识。方法回顾性分析我院自2000年1月至2004年12月间收治的6例原始神经外胚叶肿瘤患儿的年龄、性别、发病部位、临床症状、转移部位、病理特征和治疗方案及预后。结果6例患儿中除左上臂肿块患儿接受了扩大根治术目前尚存活外，其余5例患儿皆因肿块巨大，无法切除或切除困难（眼球后肿瘤患儿）而行肿块活检术，且均死亡，平均存活时间为10.3月。6例患儿均接受了不同方案的化疗，平均化疗时间为7．5月，均未接受放疗。结论原始神经外胚叶肿瘤是一种来源于神经外胚叶组织的小细胞恶性肿瘤，具有早期诊断困难，治疗棘手，死亡率高的特点。     

Enteral Nutritional Support by Percutaneous Endoscopic Gastrostomy in Children with Congenital Heart Disease

One of the major problems of children with severe congenital heart disease (CHD) is their poor nutritional status. Among other consequences, it influences the surgical outcome. Retrospectively we present our experience with percutaneous endoscopic gastrostomy (PEG) in 15 children with CHD. This technique allows enteral nutritional support without the disadvantages related to long-term nasogastric tube feeding. Major complications were absent, and minor complications were rare both at PEG insertion, which was performed under deep sedation, and during feeding via PEG tube. In 4 of the 8 children who were followed for at least 6 months the age-matched body weight increased more than one standard deviation. In 2 other patients it increased more than 0.5 standard deviations. In 7 children the tube was removed after 2.5 to 42 months since enteral support was no longer necessary. Apart from initial reservations the parental acceptance of PEG was good. We conclude that the PEG is a safe and reliable technique to support enteral nutrition in children with severe CHD.     

Development and Validation of the Both Hands Assessment for Children With Bilateral Cerebral Palsy

Aims: To develop a hand function test for children with bilateral cerebral palsy (CP) measuring bimanual performance, including quantification of possible asymmetry of hand use. Method: The Both Hands Assessment (BoHA) content was developed through adaptation of the Assisting Hand Assessment (version 5.0). Data from 171 children with bilateral CP, 22-months to 13 years olds (75 females; mean age: 6 years and 6 months) classified at Manual Ability Classification System (MACS) levels I-III, was entered into Rasch measurement model analyses to evaluate internal scale validity and aspects of reliability. Results: Sixteen items (11 unimanual and 5 bimanual) exhibited evidence for good internal scale validity and item and person reliability when analyzed separately for children with asymmetric or symmetric hand use. By calibrating the BoHA logit measures into the same frame of reference through linking, the overall measure of bimanual performance is comparable between children with asymmetric or symmetric hand use, still allowing use of separate item difficulty hierarchies. Conclusions: The Both Hands Assessment (BoHA), showed strong evidence of internal construct validity for measuring effectiveness of bimanual performance and the extent of asymmetric hand use in children with bilateral cerebral palsy, MACS levels I-III.     

介入治疗在小儿腹部恶性肿瘤的应用

目的 对巨大腹部肿瘤采用介入治疗,为肿瘤完整切除创造有利条件。方法 对１２例腹部恶性肿瘤患儿进行介入治疗,其中男７例,女５例。年龄２个月￣７岁。肝母细胞瘤６例,神经母细胞瘤３例,肾母细胞瘤２例肾上腺皮质癌１例。采用Ｓｅｌｄｉｎｇｅｒ’ｓ技术进行动脉插管造影,确定肿瘤主要供血动脉,进行肿瘤供血动脉超选择性插管,局部注入化疗药物,然后用碘油、明胶海绵或白芨微球栓塞肿瘤的供血动脉。结果 １２例中７例手术